Drug Takes Wrinkle Out Of Skin Care

January 11, 1992|By RONALD KOTULAK, Chicago Tribune

One of the foremost signs of aging -- wrinkled, dry, leathery, splotchy skin -- was always thought to be permanent. But, using chemical erasers that appear to work on the genetic level, scientists are finding that these changes in older skin can be reversed to some extent.

Impressive results in making aged skin youthful were achieved in the largest study ever conducted with a chemical called tretinoin, the active ingredient in the anti-acne medication Retin A.

``There was less wrinkling, less pigmentation and a smoothing of the skin,`` said Dr. Gerald Weinstein, chief of dermatology at the University of California at Los Angeles, who headed the study involving 250 people.

``If you want to put that together and say that the skin of these people looked better, yes, it looked better,`` he said.

Tretinoin and other retinoids are synthetic cousins of vitamin A, which plays important roles in maintaining the health of cells and is thought to protect against cancer. Scientists believe one of tretinoin`s jobs is to repair damaged genes, such as those that appear to be implicated in wrinkled skin.

In the study, neither the volunteers nor the doctors knew which subjects were rubbing tretinoin on their skin and which were using a moisturizer without the compound.

Significant improvement was seen in 79 percent of the volunteers using tretinoin but in only 48 percent of those using the moisturizer, Weinstein said. The improvement shown by subjects using only the moisturizer suggests that better care of any kind can help skin retain its youthful appearance, he said.

Skin ages in two ways. The most important aging mechanism is called photo- aging because up to 90 percent of the changes that occur in older skin are caused by sun damage. This becomes apparent when comparing parts of the body not normally exposed to the sun, such as the smooth skin of the thighs and buttocks, with parts directly exposed, like the face and hands.

Unexposed skin undergoes so-called natural aging. This skin is thinner, more delicate, almost translucent and has fine wrinkles.

Sun-damaged skin is coarse and has deep wrinkles and furrows.

Wrinkles and other changes caused by the sun are believed to be caused by ultraviolet damage to genes in the skin`s basement layer. It is from this layer that new skin cells constantly are being produced, working their way up the 15 layers of the epidermis to the surface in two to four weeks.

But basement cell genes damaged by the sun`s radiation keep reproducing that damage in the new skin cells, like an assembly line producing faulty parts. The new cells bear the marks of damage in the form of wrinkles, leathery texture and discoloration. More severe damage to genes may cause skin cancer.

Tretinoin may restore the damaged genes to their normal form, thereby accounting for the disappearance of some wrinkles and other improvements seen in the skin, said Dr. Barbara Gilchrest, a dermatologist with the Boston University Medical School.

``At the beginning of the study, many of the subjects had blotchy, irregularly pigmented skin,`` she said. ``As the study went on, these age spots got lighter or went away.``

Dr. Albert Kligman of the University of Pennsylvania, who developed Retin A to treat acne 20 years ago, said it was his patients who alerted him to the possibility that the compound could erase wrinkles.

``I didn`t discover its anti-aging skin effects; they did,`` he said.

Tretinoin can cause minor side effects such as scaling and redness, but these usually can be controlled by using moisturizers and sunscreens, Kligman said. Because the demand is high for tretinoin, many doctors are prescribing it without telling patients how to use it correctly, he cautioned.

Kligman`s latest research in people 80 and older shows that tretinoin also restores some youth to unexposed thigh skin that has not been prematurely aged by the sun. The promising results indicate the compound has true anti-aging properties beyond its beneficial effects on photo-aged skin, he said.

``This opens up the field,`` he said. ``It is the first drug that substantively reverses some of the aging changes of the skin, and it tells you that if tretinoin can do it ... there will be other anti-aging skin drugs.``

Other compounds to reverse aging skin are being tested.

Dr. Eugene Van Scott, a Philadelphia dermatologist, is using fruit acids, called alpha hydroxy acids, to decrease dryness and discolorations and make skin appear smoother.

Although it is not known how the fruit acids work, large clinical trials indicate that daily applications are producing positive results, he said. Perhaps the effect is something that the ladies of the French court knew, he said, adding that they supposedly washed their faces in old wine that contained fruit acids.

``The three things we know that act as anti-aging compounds on the skin`s epidermis and dermis are vitamin C, retinoids and the alpha hydroxy acids,`` Van Scott said.

Another compound that appears to be showing promising results is vitamin E. Mice rubbed with vitamin E-containing compounds were found to be more resistant to the sun`s damaging ultraviolet radiation.

``It`s possible,`` Kligman said, ``that one day we`ll get up in the morning and shower ourselves with retinoids or some such thing to help our skin stay younger longer.``